Provider Demographics
NPI:1083745756
Name:BLACK & ASSOCIATES GLOBAL INC
Entity Type:Organization
Organization Name:BLACK & ASSOCIATES GLOBAL INC
Other - Org Name:OUR HOME - AUNT ZOLA'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:336-987-0572
Mailing Address - Street 1:102 BURROWS RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8400
Mailing Address - Country:US
Mailing Address - Phone:336-987-0572
Mailing Address - Fax:336-454-0191
Practice Address - Street 1:408 ANDREW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1515
Practice Address - Country:US
Practice Address - Phone:336-271-2004
Practice Address - Fax:336-454-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 041-781320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603997Medicaid